Lazy eye is treatable, but must be caught early By Amy Smithphoto by Frank Pinc Jack Salzman of Chicago, smiles as his mother looks on. Salzman's mother is chair of a statewide coalition to educate parents on amblyopia or lazy eye.
There were no obvious signs that anything was wrong. Besides, Jack could read. So how was anyone to know he couldn't see out of his left eye?
Then Salzman discovered her only son had amblyopia, a condition in which vision is weaker in one eye than the other. The diagnosis came as a shock. She had never heard of amblyopia, even though she managed optical stores for 15 years.
"His eyes looked perfectly normal," Salzman says. "Little did we know he had no vision in one eye."
Salzman now is working to promote awareness about the condition that affects an estimated two to three out of every 100 children.
"You do everything you can do, and then to find out the whole time that your child doesn't have vision in one eye," Salzman says. "You're stunned. You think you crossed your I's and dotted your T's. You think, ‘How did I miss this? I dropped the ball.' You think you failed him as a parent. There's a lot of guilt because it's preventable."
Amblyopia, also known as "lazy eye," is the most common cause of preventable vision loss in the United States, but many parents have not heard of it, according to medical experts. Vision impairment in one eye can be a result of unequal focusing, or anisometropia, the most common form of amblyopia. The second most common form is crossed eyes, also known as strabismus. Other conditions such as cataracts or retinal damage also can cause amblyopia.
"Amblyopia silently robs sight from a child's eye," says Jack's doctor, David G. Hunter, who is chief of ophthalmology at Children's Hospital Boston and an associate professor at Harvard Medical School.
Training the brain "It's something that's causing his brain to ignore that eye," Hunter explains of the children's condition. "The brain needs to learn to use the eye in order to see."
Dr. Kimberlee Curnyn, a clinical assistant professor of ophthalmology and visual sciences at the University of Illinois at Chicago says "amblyopia means the brain doesn't fully develop vision in one eye." Curnyn also practices pediatric ophthalmology in Arlington Heights and Elk Grove Village.
Vision use is key in early development. "If one or both eyes are not used in development, a part of the brain doesn't develop properly," says Dr. Benjamin Ticho, head of pediatric ophthalmology at Christ Medical Center's Hope Children's Hospital in Oak Lawn and an assistant professor at the University of Illinois at Chicago.
As the Salzmans can attest, the condition can be difficult to diagnose. Children can have a vision problem even if their eyes look normal. That's why doctors emphasize the importance of routine checkups beginning at birth and a vision screening at least once before age 5.
"A lot of these kids also have a crossed eye. Some do not," says Dr. James McDonnell, director of pediatric ophthalmology and adult strabismus at Loyola University Medical Center. "Those are the most difficult to diagnose. The only way to pick these up is on a screening exam."
In addition to crossed eyes, children who frequently tilt their head can be an indicator of amblyopia. Jack's first-grade teacher noticed he tilted his head a lot. He also often missed the mark when he was placing objects because he didn't have depth perception.
Other possible indicators include squinting, a drooping eyelid, a child who has difficulty walking and often bumps into things or a noticeable difference between one eye and the other in the "red eye" reflection in pictures.
Treatment involves making the weaker eye work harder. That can be done by wearing a patch over the normal eye, glasses, once-a-day eye drops to blur the good eye or a combination of these treatments.
Wearing a patch may treat the problem more quickly, but drops are a good choice for children who will not tolerate wearing a patch. Some children may require surgery to correct another problem such as a cataract before amblyopia treatment can begin.
The length of treatment depends on the cause and severity of the condition as well as the age and temperament of the child. Most children need to wear a patch a few hours each day. Treatment can take as little as a few months or as long as a year or more.
The younger, the better Treatments work best if started before age 5. If left untreated, the chances of successfully correcting the problem diminish greatly and permanent vision problems can result.
"The earlier in life it's diagnosed, the easier it is to treat," Hunter says.
Curnyn agrees: "The older you get, the more difficult it is to train the brain to do new things."
Maureen Daday, 9, of Arlington Heights, one of Curnyn's patients, has been treated for amblyopia since she was 2½ months old. Her amblyopia is a result of morning glory syndrome, a condition in which her right optic nerve is underdeveloped and leads to a crossed eye. She wears a contact lens in her right eye as treatment.
When she was 6, she began wearing the contact lens, though she wore glasses as an infant. Until she was 7, Maureen wore a patch over her left eye. She now wears glasses to protect her good eye, which doctors say is important because children with the condition are at greater risk of injury because of their impaired vision.
"She wasn't responding visually at all as an infant," says her mother Eileen. When she started wearing glasses at 3 months, she improved quickly. "Within a month, she started smiling and responding."
Medical experts stress that amblyopia is a treatable condition.
"Most patients with amblyopia, if detected and treated in a timely fashion, can significantly improve," Ticho says.
Jack Salzman and Maureen Daday are evidence of that.
"She's so outgoing," Maureen's mother says of her daughter. "She doesn't think of herself as having a disability, and her peers don't either. She's very popular in school."
Jack's mother is grateful to Hunter for what he has done for her son. "He'll never have 20/20 vision, but he regained most of his sight," she says.
Jack, now 8, was treated with atropine eye drops for nearly a year. Now the vision in Jack's left eye is 20/25, a major improvement from 20/160. He has been off medication for several months and now only has to wear glasses.
"His quality of life has improved by 200 percent," his mother says. "He's happier because he can see better. He's more confident. He's engaging more with other kids."
Illinois takes action against amblyopia Illinois first lady Patti Blagojevich is spearheading a statewide initiative to diagnose and treat amblyopia. The Illinois Pediatric Vision Amblyopia Awareness Initiative is the first of its kind in the country.
The initiative, which began with a task force in October 2003, involves various state departments, including the state's departments of human services, public aid, public health and child services, the State Board of Education and the Chicago Public Schools. It also has drawn in the Illinois Optometric Association, the Illinois Association of Ophthalmology, the Illinois Chapter of the American Academy of Pediatrics, the Illinois Pediatric Vision Foundation and Children's Hospital Boston, under the guidance of Dr. David Hunter.
The goal is to distribute 1 million flyers about the condition, both in English and Spanish. Lee Maher Salzman is chairwoman of the statewide initiative team and a friend of the first lady. Salzman says she called Blagojevich as soon as she learned of her son's diagnosis; the two women decided to team up to help create public awareness.
"We want parents to learn about this," Salzman says. "There's lots that can be done. We want to make parents and pediatricians aware."
Salzman says the team is looking toward better training for vision screeners.
For more information, contact the Illinois Department of Public Health Vision and Hearing Program help line at (800) 545-2200 (voice) or (800) 547-0466 (TTY).
Amy Smith is a graduate student at Northwestern University's Medill School of Journalism and writes for the Medill News Service.